Feeding tubes for the terminally ill and patients in a “vegetative state”

On May 30, 2007, Jesse Ramirez’s car flipped over. The Arizona man was left with major brain injuries. The doctors told his wife that her 36-year old husband could remain in a permanent vegetative state. Less than two weeks after the accident, she asked doctors to remove his food and water tubes. Jesse Ramirez depended on feeding tubes for food and water for life. Without them, he would certainly die in circumstances very similar to the tragic death of Terri Schiavo in 2005. But Jesse’s family challenged his wife’s decision in court. Maricopa County Superior Court Judge Paul Katz ordered the tubes reconnected. Ramirez regained consciousness.

Cardiac arrest lasting for more than three minutes normally results in death. When 19-year old Larisa Zimnuknova’s heart stopped beating because of the improper administration of the anesthetic, doctors were able to get her heart beating again. However, the patient remained unconscious. After two years, she awoke from her slumber. Dr. Alexander Belyavsky, department head of the Rostov State Medical University, said that the most difficult part of treating Larisa was the opposition from those who read her EEG (http://english.pravda.ru/world/2001/09/20/15776.htm). Without the administration of food and drink by artificial means, Larisa would have died.

The lists of individuals who awake from what some call a “vegetative state” is impressive. A study by the Coma Science Group of the University of Liège, Belgium, reveals that up to half of patients in an acute vegetative state regain some level of consciousness. On August 1, 2007, in answer to questions submitted to the Congregation for the Doctrine of the Faith by the bishops of the United States, the Holy See issued a response that helps to clarify the difficult decision of whether or not it is morally obligatory to provide nutrition and hydration by artificial means in such cases.

In Catholic moral teaching, there has always been a distinction between ordinary and extraordinary means to preserve life. Pope Pius XII introduced this distinction. He said that, in the case of a grave illness, there is a duty to provide the ordinary care necessary to preserve life. But there is no moral obligation to use those means that would impose an extraordinary burden on the patient or on others (Pope Pius XII,
Address to the Congress on Anesthesiology, November 24, 1957).

The Pope’s remarks were actually directed to the use of the various techniques of resuscitation. They had nothing to do with providing food and drink to the terminally ill or to those in a prolonged state of unconsciousness. Yet, many people have applied this distinction to the administration of food and drink by artificial means. They see it as an extraordinary means for a person who is seriously disabled or terminally ill.

Pope John Paul II spoke unambiguously on this issue. He said that nutrition and hydration are to be considered
ordinary means for preserving human life. To withhold them so as to cause the death of another is euthanasia by omission. It is morally unacceptable (Pope John Paul II,
ad limina Address to United States Bishops, October 2, 1998).

He also said that “the administration of water and food, even when provided by artificial means, is a
natural means of preservation of life, not a
medical act. Its use, therefore, is to be considered, in principle,
ordinary and
proportionate and as such morally obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which … consists in providing nourishment to the patient and alleviation of suffering" (Pope John Paul II,
Address to the participants of an International Congress on “life-sustaining Treatments and the Vegetative State: Scientific progress and ethical dilemmas, March 20, 2004).

In most circumstances today, the administration of food and water by artificial means is easily provided by the average health-care system. It can be done at home. It does not place a heavy burden on the family or the patient. Thus, the administration of food and water is considered an ordinary means. It is proportionate to its purpose: preventing the patient from starving to death or dying from dehydration.

There are cases of individuals who simply cannot feed themselves, e.g. a person with advanced Alzheimer’s disease, someone in an unconscious state, or a quadriplegic. These are difficult cases. They place a burden on a family. These individuals require extraordinary attention and assistance over a long period of time. But this does not mean that they may simply be left to take care of themselves and thus allowed to die. Providing food and drink is obligatory as long as it can accomplish its purpose of nutrition and hydration for the patient.

There are other cases where the artificial administration of food and drink may be burdensome, painful to the patient and unable to accomplish its purpose. In the case of a patient dying of stomach cancer, the administration of food and water may be of very little use and only increase the pain of dying. In such a case, it is morally acceptable not to cause the patient more pain, since the food and water are of no benefit.

When a person is not dying, but severely disabled, when the person can breathe spontaneously and digest food, and his or her death will occur not because of the illness or the lack of consciousness, but rather because of starvation and dehydration, then the administration of food and drink, even by artificial means, is morally obligatory. When a person is dying, it is morally acceptable not to intervene in an extraordinary way to prolong their life and hence their process of dying. This life is not the ultimate end of human existence. We are made for God.